| NPI | 1134355035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1303512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07416) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2018-05-24 |